Anesthetic Cooperation and Emergency Nursing Care for Awake Intubation in a Patient with Giant Goiter Complicated by Difficult Airway
Journal: Advanced Journal of Nursing DOI: 10.32629/ajn.v6i3.4392
Abstract
Objective: This study aims to explore optimized anesthetic nursing strategies for awake intubation in patients with giant goiter complicated by difficult airway, and to establish a standardized nursing process based on evidence-based guidelines. Methods: The clinical data of one patient with bilateral grade Ⅲ goiter (neck circumference 50 cm, narrowest tracheal segment 0.4 cm) was retrospectively analyzed. Key perioperative nursing points during video-assisted fiberoptic bronchoscope-guided awake intubation were summarized, including multidimensional airway assessment, stratified psychological intervention, standardized airway preparation, refined perioperative collaboration during intubation, and intraoperative risk prevention. Results: Guided by the 2022 American Society of Anesthesiologists (ASA) Practice Guidelines for Management of the Difficult Airway, the patient received dual topical airway anesthesia (2% lidocaine) via "nebulization + local spray", combined with stepwise psychological intervention and precise operational coordination. The preoperative anxiety score (measured by the Amsterdam Preoperative Anxiety and Information Scale, APAIS) decreased from 14 to 9, representing a 35.7% reduction. The first-attempt success rate of awake intubation was 100%. Intraoperative vital signs remained stable, with no complications such as airway injury or cutaneous pressure damage. The patient was discharged successfully on the 7th postoperative day without anesthesia-related complications. Conclusion: For patients with difficult airway caused by giant goiter, implementing an evidence-based systematic nursing process can significantly reduce perioperative airway risks, providing clinical reference for similar cases.
Keywords
giant goiter, difficult airway, awake tracheal intubation, fiberoptic bronchoscope, evidence-based nursing
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[14] Xu SY, Xu J, Zhu HD, et al. Strengthening difficult airway management to improve clinical treatment level: interpretation of the 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway [J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(3): 427-432.
[2] Joffe AM, Aziz MF, Posner KL, Duggan LV, Mincer SL, Domino KB. Management of Difficult Tracheal Intubation: A Closed Claims Analysis [J]. Anesthesiology, 2019, 131(4): 818-829.
[3] Wang Y, Guo XG, Zhang W. Summary and analysis of 544 perioperative adverse events [J]. Perioperative Safety and Quality Assurance, 2018, 2(5): 252-255.
[4] Jiang X, Wang ZQ, Huang H, et al. Perioperative management of giant goiter causing tracheal compression and stenosis [J]. Journal of Surgical Theory and Practice, 2015, 20(1): 53-56.
[5] Zhou JA, Luo CY, Zhang J, et al. Giant goiter resection under a multidisciplinary diagnosis and treatment model [J]. Chinese Journal of Minimally Invasive Surgery, 2022, 22(6): 472-476.
[6] Zuo MZ, Su DS, Sun XL. Safe airway management: an eternal theme for anesthesiologists: interpretation and analysis of hotspots at the 2nd World Airway Management Congress [J]. Chinese Journal of Anesthesiology, 2020, 40(1): 13-17.
[7] Gao HB, Xiao SL, Wang QY, et al. Research progress in topical airway anesthesia techniques for awake tracheal intubation [J]. Journal of Clinical Anesthesiology, 2023, 39(1): 81-84.
[8] Liu YR, Wang Y, Li JJ, et al. Interpretation of the 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway [J]. Journal of Clinical Anesthesiology, 2022, 38(6): 643-647.
[9] Scherr A, Schmidlin J, Albisser S, Tamm M, Stolz D. Airway reactivity to mannitol is similarly increased in chronic cigarette and water pipe smokers [J]. Int J Chron Obstruct Pulmon Dis, 2018, 13: 157-163.
[10] Chinese Guidelines and Expert Consensuses on Anesthesiology (2021 Edition) - Expert Consensus on Preoperative Anti-Anxiety.
[11] Li Y, Huang XF. Nursing cooperation experience in one case of anesthesia for difficult airway due to giant lipoma of the floor of the mouth [J]. Gansu Medical Journal, 2022, 41(4): 365-367.
[12] Luo JN, Zhang ZL, Fu L. Clinical study on fiberoptic bronchoscope-guided nasal tracheal intubation in patients with difficult airway due to giant goiter [J]. Famous Doctors, 2020(7): 22-23.
[13] Zhao WY, Liu RJ. Effects of different intraoperative positions on post-thyroidectomy position syndrome and intraoperative respiratory circulation [J]. Perioperative Safety and Quality Assurance, 2024, 6(6): 318-321.
[14] Xu SY, Xu J, Zhu HD, et al. Strengthening difficult airway management to improve clinical treatment level: interpretation of the 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway [J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(3): 427-432.
Copyright © 2025 Yi Wu, Hongyu Shen, Zemin Zhan, Milan Xiao, Shuying Liang
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